Provider Demographics
NPI:1780034942
Name:KOHLSTADT, INGRID (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:
Last Name:KOHLSTADT
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 PRINCE GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1724
Mailing Address - Country:US
Mailing Address - Phone:410-858-4989
Mailing Address - Fax:
Practice Address - Street 1:198 PRINCE GEORGE ST
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1724
Practice Address - Country:US
Practice Address - Phone:410-858-4989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD477792083B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine